Professor, Epidemiology and Health Promotion; Director, Graduate Program in Clinical Research New York University College of Dentistry

The California Dental Association has commissioned a
study by Dr. Ananda P. Dasanayake, professor of
epidemiology and health promotion and director of the
Graduate Program in Clinical Research, to evaluate the
safety, quality, cost benefit, and patient satisfaction of
the procedures provided by non-dentist providers. Dr.
Dasanayake is the lead author on the study, whose coauthors
include Dr. Robert Norman, research associate professor of
epidemiology and health promotion, Dr. B. S. Brar, a junior
research scientist in epidemiology and health promotion,
Dr. V. Ranjan, a graduate student in the Department of
Epidemiology and Health Promotion, all of NYUCD, and Dr. S.
Matta of Columbia University's faculty of dental medicine.
The study has been submitted for publication to the
Journal of the California Dental Association.

Citing as the rationale for the study the fact that
there has been a noticeable imbalance among the dental
treatment needs of the US population and the availability,
utilization of oral health services, and the emergence of a
new group of non-dentist providers, who do both reversible
and irreversible procedures, Dr. Dasanayake and his
coauthors did a systematic review of the existing
literature on all available models of non-dentist
providers, including dental assistants, dental hygienists,
expanded function dental assistants and hygienists, New
Zealand and Canadian models, and Dental Health Aide
Therapists in Alaska, as well as several categories of
non-dental providers that have been proposed or are under
consideration in the US, including the Advanced Dental
Hygiene Practitioner (a model proposed by the American
Dental Hygienists' Association—see related
article; the Minnesota Dental Therapist model; and the
Community Dental Health Coordinator (a model proposed by
the American Dental Association—see related
article).

The investigators' primary question was: "Are the
irreversible procedures performed by any non-dentist
provider category safe compared to the same procedures
performed by dentists?" They concluded that while available
evidence is sufficient to state that the non-dentist
providers are capable of providing safe and high-quality
reversible procedures while enhancing practice
productivity, the evidence in relation to the irreversible
procedures-related outcomes is insufficient to draw
conclusions.

When published in the Journal of the California
Dental Association, the study's findings are virtually
certain to add to the debate about the need to expand the
dental workforce to meet the oral health needs of the US
population. Having completed the study, Dr. Dasanayake is
thinking ahead to the need for the "gold standard" in
clinical research: Randomized controlled trials, which can
allocate various procedures to different types of providers
who are allowed to perform such procedures and then measure
the key outcomes, such as safety, quality, effectiveness,
economic considerations, and patient satisfaction. Such
data are not currently available. "The challenge," says Dr.
Dasanayake, "is to properly 'mask' the study. The
alternative is to use existing practice-based research
networks to do follow-up studies to measure the same
outcomes in a prospective or a retrospective fashion."